TY - JOUR

T1 - Colonoscopy performance monitoring

T2 - do we need to adjust for case mix?

AU - Pedersen, Lasse

AU - Bernstein, Inge

AU - Lindorff-Larsen, Karen

AU - Carlsen, Charlotte

AU - Gerds, Thomas

AU - Torp-Pedersen, Christian

N1 - Publisher Copyright: © 2023 Informa UK Limited, trading as Taylor & Francis Group.

PY - 2023

Y1 - 2023

N2 - Introduction: Overall caecum intubation rate(oCIR) and overall polyp detection rate(oPDR) have been proposed as performance indicators, but varying complexity in case mix among endoscopists may potentially affect validity. The study aims to explore the effect of adjusting for case mix on individual endoscopist performance by calculating case mix-adjusted performance estimates (cmCIR and cmPDR) and comparing them to overall performance estimates (oCIR and oPDR). The study also provides an R program for case mix analysis. Methods: Logistic regression associated endoscopist, colonoscopy indication, patient age and patient gender with the binary outcomes of cecum intubation and polyp detection. Case mix-adjusted performance indicators were calculated for each endoscopist based on logistic regression and bootstraps. Endoscopists were ranked from best to worst by overall and case mix-adjusted performance estimates, and differences were evaluated using percentage points(pp) and rank changes. Results: The dataset consisted of 7376 colonoscopies performed by 47 endoscopists. The maximum rank change for an endoscopist comparing oCIR and cmCIR was eight positions, interquartile range (IQR 1–3). The maximum change in CIR was 1.95 percentage point (pp) (IQR 0.27–0.86). The maximum rank change in the oPDR versus cmPDR analysis was 17 positions (IQR 1.5–8.5). The maximum change in PDR was 11.21 pp (IQR 2.05–6.70). Three endoscopists improved their performance from significantly inferior to within the 95% confidence interval (CI) range of performance targets using case mix-adjusted estimates. Conclusions: The majority of endoscopists were unaffected by adjustment for case mix, but a few unfortunate endoscopists had an unfavourable case mix that could invite incorrect suspicion of inferior performance.

AB - Introduction: Overall caecum intubation rate(oCIR) and overall polyp detection rate(oPDR) have been proposed as performance indicators, but varying complexity in case mix among endoscopists may potentially affect validity. The study aims to explore the effect of adjusting for case mix on individual endoscopist performance by calculating case mix-adjusted performance estimates (cmCIR and cmPDR) and comparing them to overall performance estimates (oCIR and oPDR). The study also provides an R program for case mix analysis. Methods: Logistic regression associated endoscopist, colonoscopy indication, patient age and patient gender with the binary outcomes of cecum intubation and polyp detection. Case mix-adjusted performance indicators were calculated for each endoscopist based on logistic regression and bootstraps. Endoscopists were ranked from best to worst by overall and case mix-adjusted performance estimates, and differences were evaluated using percentage points(pp) and rank changes. Results: The dataset consisted of 7376 colonoscopies performed by 47 endoscopists. The maximum rank change for an endoscopist comparing oCIR and cmCIR was eight positions, interquartile range (IQR 1–3). The maximum change in CIR was 1.95 percentage point (pp) (IQR 0.27–0.86). The maximum rank change in the oPDR versus cmPDR analysis was 17 positions (IQR 1.5–8.5). The maximum change in PDR was 11.21 pp (IQR 2.05–6.70). Three endoscopists improved their performance from significantly inferior to within the 95% confidence interval (CI) range of performance targets using case mix-adjusted estimates. Conclusions: The majority of endoscopists were unaffected by adjustment for case mix, but a few unfortunate endoscopists had an unfavourable case mix that could invite incorrect suspicion of inferior performance.

KW - adenoma detection rate

KW - cecum intubation rate

KW - Colonoscopy

KW - performance monitoring

KW - polyp detection rate

U2 - 10.1080/00365521.2023.2175182

DO - 10.1080/00365521.2023.2175182

M3 - Journal article

C2 - 36756743

AN - SCOPUS:85147752219

VL - 58

SP - 937

EP - 944

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 8

ER -